Resource Library

The Affordable Care Act (ACA) strengthened Medicare and Medicaid and created important coverage avenues and consumer protections for people of all ages. Despite these successes, the health law continues to face opposition from some policy corners in Congress, the states, some presidential administrations, and the courts.

Some policymakers support turning Medicare into a premium support system, also called a defined contribution system or a voucher program. These programs would give people with Medicare a voucher or coupon to purchase health coverage. If the voucher did not cover the full cost—a certainty, given the aim of such programs is to save Medicare dollars—the person would presumably have to pay the rest or go without coverage. Though touted as a cost saver, a hallmark of these policies is to instead shift significant expenses onto consumers.

Policymakers often overlook or disregard the problems people may face when they try to enroll or stay enrolled in public programs or to get the care they need. Issues around Medicare and Medicaid enrollments and appeals are legion and can run the gamut from minor one-time annoyances to recurrent bureaucratic nightmares.

Medicaid is financed and administered through a federal-state partnership. Under current law, the federal government matches state Medicaid spending based on a statutory formula, without a pre-set limit. If state spending increases, for example due to increased enrollment or unexpectedly high program costs, then federal spending increases as well.

Medicare is a nearly universal program for people 65 and over, guaranteeing health care for older adults who have paid into the system during their working lives. This ensures that older adults do not have to continue to rely on employer health insurance and can retire at 65 without risking coverage loss. Some policymakers want to delay access to Medicare by raising the eligibility age from 65 to 67 or even 70. This would disproportionately harm people who can least afford it, including people who work in physically demanding jobs and older adults of color.

The Inflation Reduction Act (IRA) of 2022 made key changes in Medicare law and coverage to improve prescription drug affordability for older adults and people with disabilities. Since its passage, however, some stakeholders and lawmakers have targeted IRA policies for revision or repeal, especially the law’s Medicare Drug Price Negotiation Program.